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1457652679 NPI number — JOHN DEWAYNE POWELL CRNA

NPI Number: 1457652679
Health Care Provider/Practitioner: JOHN DEWAYNE POWELL CRNA

Information about “1457652679” NPI (JOHN DEWAYNE POWELL CRNA) exists in 1457652679 in HTML format HTML  |  1457652679 in plain Text format TXT  |  1457652679 in PDF (Portable Document Format) PDF  |  1457652679 in an XML format XML  formats.

NPI Number : 1457652679 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457652679",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "POWELL",
    "FirstName": "JOHN",
    "MiddleName": "DEWAYNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CRNA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "406 S 30TH AVE",
    "SecondLineMailingAddress": "SUITE 202",
    "MailingAddressCityName": "YAKIMA",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98902-3713",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "509-972-1051",
    "MailingAddressFaxNumber": "509-972-4166",
    "FirstLinePracticeLocationAddress": "406 S 30TH AVE",
    "SecondLinePracticeLocationAddress": "SUITE 202",
    "PracticeLocationAddressCityName": "YAKIMA",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98902-3713",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "509-972-1051",
    "PracticeLocationAddressFaxNumber": "509-972-4166",
    "EnumerationDate": "11/04/2010",
    "LastUpdateDate": "12/28/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "367500000X",
          "TaxonomyName": "Certified Registered Nurse Anesthetist",
          "LicenseNumber": "AP60197964",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": "085546",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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